World Social Psychiatry

PERSPECTIVE/VIEWPOINT
Year
: 2019  |  Volume : 1  |  Issue : 1  |  Page : 39--42

Social psychiatry: A global and indian perspective


Shridhar Sharma 
 Emeritus Professor, National Academy of Medical Sciences, New Delhi, India

Correspondence Address:
Prof. Shridhar Sharma
Emeritus Professor, National Academy of Medical Sciences, New Delhi
India

Abstract

The future germinates in the soil of the present and has its root in the past. In 2019, the World Association of Social Psychiatry (WASP) completes its 55 years. To have any vision for the future of social psychiatry, stock-taking of the past, assessment of the present activities, and a vision for future are warranted. As a past president of the WASP and a Founder Member of the Indian Association for Social Psychiatry (IASP), I present this broad overview of the various historic-political forces behind the movement of social psychiatry (including a forgotten and unpleasant past), trace the development and activities of WASP and IASP, and try to figure out a foreseeable and sustainable future for social psychiatry. The new journal of WASP, the World Social Psychiatry, can play an important role in this by advocacy, research, and dissemination of knowledge.



How to cite this article:
Sharma S. Social psychiatry: A global and indian perspective.World Soc Psychiatry 2019;1:39-42


How to cite this URL:
Sharma S. Social psychiatry: A global and indian perspective. World Soc Psychiatry [serial online] 2019 [cited 2020 Aug 10 ];1:39-42
Available from: http://www.worldsocpsychiatry.org/text.asp?2019/1/1/39/267957


Full Text



 The Past (Including a Forgotten and Unpleasant Chapter!)



In 1803, Reil et al. introduced the word psychiatry in Germany.[1] After 100 years in 1903 that the term “social” was first linked to psychiatry, when Ilberg from the Großschweidnitz asylum in Saxony, Germany, wrote a paper entitled simply “Soziale Psychiatrie.”[2] Ilberg defined social psychiatry as a theory of the detrimental influences that affected the mental health of the whole population (Gesamtheit) and as a useful means for their prevention.

Ilberg suggested that about 60%–70% of all mental diseases exhibited a hereditarian component. Thus, the first task of social psychiatry was to prevent intermarriage between healthy and mentally ill persons. The second task concerned the fight against syphilis, which was rampant during this period and caused progressive paralysis and dementia paralytica. Third, he argued for a campaign against excessive alcohol consumption, which was a major health problem. Fourth, he felt that it was essential for several professional groups in the society to become familiar with psychiatric knowledge, among them lawyers, priests, and teachers could play an important role.

In 1911, Fischer[3] advocated psychiatric care outside the asylums and called this kind of extramural psychiatry “Soziale Psychiatrie.” He further stressed, without social psychiatry, there would be no psychiatry.[4] During the same period, Kolb[5] stressed that asylum care and extramural psychiatric care were two inseparable and complementary parts of one single system of mental health care. After a cost–benefit analysis, he suggested that this kind of open psychiatric care was “natural progress” because it enabled mental health care to achieve a maximum of efficacy with a minimum of expenditure.

Kolb also outlined five specific tasks to meet this objective: first, the reintegration of discharged mentally ill patients with their families and occupations; second, the scientific, statistical, and sociomedical registration of all mentally ill and abnormal people outside the asylums; third, the consolidation of all local asylums and other caring institutions according to psychiatric principles; fourth, the publication of psychiatric knowledge and experience of the mentally ill living outside the asylums; and fifth, to spread awareness about mental hygiene principles in order to prepare for preventive intervention in the community.

It is worth recalling that it was in the Heidelberg Clinic that Kraepelin introduced the methods of experimental psychology for the study of fatigue, dreams, and drugs. Dr. Nissel succeeded Kraepelin. His interest centered on neuroanatomy and neuropathology. Heidelberg was an important psychiatric center where many eminent young psychiatrists worked, which included names like Adolf Meyer, Eric Cuttman, and Mayer Gross. Similarly, Rüdin[6] in one of his papers had stated that Kraepelin[7] had also taken a social psychiatric approach, indeed a psychiatric-racial hygienic approach (”sozialpsychiatrisch, ja psychiatrisch-rassenhygienisch”). “Social psychiatry” was thus reduced to the concept of prevention based on biological interventions, such as sterilization and Eugenic approach. This approach proved fatal for social psychiatry movement.

Thus, in 1940, the term social psychiatry lost its previous wide spectrum of connotations and was narrowed down to issues in line with the National Socialist politics. During the National Socialist Germany, the social status of the mentally ill worsened considerably, and the ability to work became an obligation for patients. During the Third Reich period, a criterion for selection that determined whether they would live or die.

Between 1939 and 1945, many psychiatrists in Germany participated in the largest systematic program to kill patients known in the history of medicine.[8] According to recent estimates, a total of at least 260,000 patients suffering from mental illnesses and mental retardation were murdered.

After 1945, the term “social psychiatry” was not used as it was highly stigmatized. Despite the fact that psychiatrists referred to specific historical examples, they preferred the terms “Resozialisierung” (resocializing) and “Rehabilitation” (rehabilitation) in order to describe their endeavors,[9] and they avoided the term social psychiatry for almost two decades after the Second World War.

 The Present: Man, Molecule, Mind….and Milieu



There is a complex relationship between the molecular biology of the cell and the social environment.

The mind is now the domain of the collection of small, sometimes overlapping disciplines ranging from molecular psychiatry, dealing like neurobiology with molecules in a cell, to social psychiatry, and the final holistic output of the complex interplay of genes and social environment. Molecular events in brain cells have repercussions on the person's social environment; and that, reciprocally, such molecular events may at times be influenced by happenings in the environment. In this landscape, our aim should be for decompartmentalization of scientific boundaries with a more unified and integrated scientific approach to the problems of society at large and the individual minds that comprise our societies.

The social environment concept is much more abstract and includes constructs such as social cohesion and culture, shared values, economic conditions and globalization, threat by an enemy, and the expectation of survival (Marsella 1998;[10] Stuckler et al., 2009).[11] These are macrosocial phenomena, sometimes difficult to define with precision or to measure, but nevertheless attributes of a society which certainly influence behavior in daily life and which may promote suicidal behavior, violence, hysteria, or inhibit some types of mental disorder.

Recent Analysis of European Union data for the past 30 years found that each 1% rise in unemployment was associated with an overall proportionate increase in suicidal rates.[12] Similar trends have been reported in Farmers in India.[13] Khan[14] from Pakistan has proposed that in Pakistan, the sociodemographic profile of suicide bombers comprised young people with a background of poverty, poor education, unemployment, and lack of social support.

Recent increase of violence and rapes are other areas which need attention. The method of social psychiatry reflects its concern with the assessment of the individual and his environment. This, in its simplest form, entails a thorough psychobiological inventory of an individual, his life history and his total life situation. Such an inventory utilizes not only psychological factors, but also utilizes the clinical skills of the psychiatrist, and perhaps, those of the anthropologist or sociologist familiar with the ramifications of the patient's environment. Recently, Häfner[15] published some interesting German data on 25 years of research into schizophrenia, linking the role of social factors into schizophrenia. In 2004, Sharma[16] highlighted the role of globalization and mental health.

Social psychiatry is a “point of view”

Such a view focuses on the social dimension of mental health, mental illness, and mental health care. If it is applied to the wide field of psychiatry, three distinct connotations of social psychiatry result. First, as a scientific specialty, social psychiatry uses concepts and methods of social sciences, including psychology and anthropology, to investigate social factors influencing and relevant to occurrence, expression, course, and care-of-mental disorders and may also deal with mental health promotion and other issues relevant to public mental health. Sometimes, it is used in combination with other terms. Social psychiatry might be seen as one of the major scientific specialties in psychiatric research, alongside biological psychiatry and possibly a “psychological” or psychotherapeutic psychiatry. Second, since the 1950s, all Western industrialized nations have seen far-reaching reforms of mental health care with a closure or downsizing of former asylums and the establishment of services in the community.

To a varying degree, the reforms were politically driven, but they were greatly influenced by the introduction of antipsychotic drugs. They were frequently called social psychiatric and the advocates were regarded as social psychiatrists. The third connotation of social psychiatry relates to the practice of mental health care. The underlying attitude was illustrated by the statement “psychiatry is social psychiatry or it is no psychiatry.” The three connotations, as outlined above, seem equally valid.

However, it is useful to be aware of the differences between the connotations and to distinguish between them.[16] Social psychiatry is of course only one component of a wider body of knowledge about mental disorders. It complements other fields such as psychopathology, biological psychiatry, clinical psychiatry, and environmental psychiatry. Human disease is more than biopathology. A biomedical model is based on “biopathology” concept. Illness implies a biosocial model based on social-pathology concept.

This hypothesis proposes an etiological factor outside the individual, in his social environment. Such a paradigm has long been a mainstay of social psychiatry, with its emphasis on extrapersonal factors as major determinants of mental disorders. Role of individual psychosocial factors, for example, schizophrenia, whose worldwide lifetime prevalence of around 1% in most social populations across the world suggests an etiology, in which genes are favored over the environment. A meta-analysis showed heritability had a liability quotient ranging from 73% to 90% and environmental factors ranging from 3% to 19%.

This variation in the latter should be a focus of social psychiatry as to what factors in society protected individuals with a genetic liability suffering from this disease. The working agenda in social psychiatry consists of those experiences taking place between people which may influence their mental health. This specifies the three main sets: the social experiences and other social variables, the characteristics of the persons, and the nature of the psychiatric morbidity.

It is also concerned with the way in which the environment affects form, distribution, frequency, treatment, management, and perpetuation of psychiatric disorders. Much of the concern of social psychiatry has been in assessing the pathogenetic significance of broad social currents such as: (a) migration, (b) acculturation, (c) industrialization, (d) urbanization, (e) discrimination and (f) automation/technology, (g) psychosocial stresses, and (h) violence to self and others.

In brief, social psychiatry has three connotations: first, the social psychiatry helps in understanding the etiology of mental illness and context of social and mental factors of health; Second, it is a social movement; and Third, how we practice mental health care in public.

Hence, the theory of social psychiatry is becoming a specialty, and it uses concepts and methods of social sciences: psychology, anthropology, their influence on the human mind and how they bring a change – how we express our emotions, how we express our grief, how we express our happiness, and all those things. So from that point of view, it is now a distinct and robust branch of psychiatry.

 A Brief History of World Association of Social Psychiatry



In 1964, Joshua Bierer in London organized the first International Congress of Social Psychiatry. The International Association for Social Psychiatry later became the World Association of Social Psychiatry (WASP). During the first two decades, the WASP activities and congress were localized mostly in European Countries. Most of these meetings were small. In general, the topics discussed were related to conflicts, war, and issues related to the cold war.

Past World Association of Social Psychiatry meetings

I London, UK 1964II London, UK 1969III Zagreb, Yugoslavia 1970IV Jerusalem, Israel 1972V Athens, Greece 1974VI Opatija, Yugoslavia 1976VII Lisbon, Portugal 1978VIII Zagreb, Yugoslavia 1981IX Paris, France 1982X Osaka, Japan 1983XI Rio de Janeiro, Brazil 1986XII Washington DC, USA 1990XIII New Delhi, India 1992XIV Hamburg, Germany1994XV Rome, Italy 1995XVI Vancouver, Canada 1998XVII Agra, India 2001XVIII Kobe, Japan 2004XIX Prague, Czech Republic 2007XX Marrakech, Morocco 2010XXI Lisbon 2013XXII Delhi, India 2016XXIII Bucharest, Romania 2019.

Past Presidents of World Association of Social Psychiatry

1964–1968 Joshua Bierer, UK founder and the organizer of the first three World Congresses of Social Psychiatry1968–1974 Jules H. Masserman, United States1974–1978 Vladimir Hudolin, Croatia, Yugoslavia1978–1983 George Vassiliou, Greece1983–1988 John L. Carleton, United States1988–1992 A. Guilherme Ferreira, Portugal1992–1996 Jorge A. Costa e Silva, Brazil1996–2001 Eliot Sorel, United States2001–2004 Shridhar Sharma, India2004–2007 Tsutomu Sakuta, Japan2007–2010 Julio Arbola-Flórez, Canada2010–2013 Driss Moussaoui, Morocco2013–2016 Thomas Jamieson-Craig, UK2016–2019 Roy Abraham Kallivayalil, India2019–Rachid Bennegadi, France.

 History of Indian Association for Social Psychiatry



In 1984, during the annual meeting of Indian Psychiatric Society in Ranchi, a core committee of Indian Association for Social Psychiatry (IASP) was formed, and the first Congress was held in Kodaikanal in Tamil Nadu, and the second in Chandigarh. The author was the founder member and President-Elect of IASP along with Prof. A. Venkoba Rao. Since then, the Indian Association has grown much stronger and is playing bigger role in the growth of the WASP. IASP, formed in 1984, joined WASP in 1985. It brings regularly the Indian Journal of Social Psychiatry. Other regular Journal is from Japan.

IASP has organized three World Congresses of Social Psychiatry and has given two Presidents to the WASP. India has also made impressive contribution to the cause of the WASP. What are the challenges and opportunities for the growth of the WASP and IASP? There are many areas in the field which need priority; some of these areas include urbanization, globalization, and national and transnational migration.[17],[18]

There is a global social crisis and, in particular, the health crisis that afflicts the developing countries. Under the free market model, health is no longer considered an absolute need: it is a private good, rather than an inalienable right. Health is subjected to forces of the free market, where free choice and competition is the golden rule.

 Looking at the Future



Today, the practice of social psychiatry is being increasingly influenced by the growth of science and technology, changing ideology of economics, and rapid urbanization and migration. This is resulting in erosion of individual and social values, needing urgent introspection. Thus, today, social psychiatry has great relevance and bright future. The new journal of WASP, the World Social Psychiatry, can play an important role in this by advocacy, research, and dissemination of knowledge.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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